ECP barriers remain

Pharmacists can do more when it comes to emergency contraception provision, says sexual health expert

Despite high awareness of the availability of emergency contraceptive pills (ECPs), there are some barriers and myths that continue to impede access for women, said sexual health physician Dr Terri Foran.

A recent survey by Marie Stopes Australia revealed common myths that are still circulating, explained Dr Foran at PSA21 conference over the weekend.

One common myth is that pharmacists cannot or simply choose not to supply the ECPs to people other than the woman taking the medication—a partner or family member, for example.

While this is not the case, Dr Foran noted that pharmacists are expected to take reasonable steps to ensure information gathered by a third party is accurate, and information provided is also transferred accurately to the user.

Further myths included that: ECPs can only be used on “the morning after”; that taking an ECP induces an abortion and affects future fertility; and that ECP is only necessary when unprotected intercourse occurs midcycle.

Other issues identified included fear of embarrassment or being judged by the provider, costs, and reduced access in rural and regional centres.

“Some studies have shown lower rates of awareness and knowledge in those at socioeconomic disadvantage,” said Dr Foran.

“More research is required to determine best ways to address gaps in health literacy regarding ECPs, possibly using consumers as co-designers.”

While a 2011 survey indicated that most Australian pharmacists (72.4%) had a high level of knowledge of the ECP, a 2021 systematic review on pharmacists’ own perceived barriers to ECP provision revealed concerns.

Pharmacists cited personal barriers such as being male or lack of confidence; logistical barriers such as the lack of a private area in the pharmacy or time constraints; and inadequate resources related to staffing and unclear protocols.

Overall patients viewed pharmacy services positively, with the main benefits cited as convenience and anonymity compared to a medical appointment.

But some studies reported negative experiences with some pharmacists who appeared judgmental about the patients request or need for the ECP.

When it comes to declining supply based on religious faith or personal beliefs, Dr Foran pointed out that while all professionals have a right to their own beliefs, the Pharmacy Board of Australia holds that the pharmacist must ensure client care even in the event of a conflict with personal moral beliefs.

“This means that the primary concern of the pharmacist must be health and wellbeing of both clients and the community,” she said.

It also means “the pharmacist should respect clients’ autonomy, dignity and right to make an informed decision [and] the pharmacist must ensure continuity of care.”

Dr Foran also emphasised that the need for patients to complete a formal checklist, which has been cited by some women as “embarrassing” and “intrusive”, is no longer recommended by PSA.

“Emergency contraception has not reached its potential as a strategy for preventing unintended pregnancy,” said Dr Foran.

“Pharmacists have an important role in addressing the barriers to EC use as educators and myth busters, knowledgeable and empathetic providers, and collaborators with other health providers.”

She also called on the government to subside costs of EC and increase access to IUDs as an emergency option.

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